Purpose We performed this study to assess the trend
of geographical disparities between rural areas located in
the catchment areas of 41 medical universities in Iran
from 1993 to 2008. We evaluated four indicators
including rates for neonatal mortality (NMR), infant
mortality (IMR), under-5 mortality (U5MR) and crude
death (CDR).
Methods We got about 656 university-year data points
for each of the indicators (missing data <0.5%). The
people under assessment were between 16.7 (in 1993)
to 20.1 million (in 2008). We measured disparities
through the calculation of index of disparities (IDisp) and
assessed the trends using the Cuzick non-parametric test
for trend.
Findings Except for the increasing trend of CDR
(Z=+2.83, p=0.005), the others had decreasing trends:
NMR (Z=-3.23, p=0.001), IMR (Z=-3.84, p<0.001)
and U5MR (Z=-3.84, p<0.001). The IDisp trends of IMR
(Z=-2.2, p=0.027) and U5MR (Z=-2.84, p=0.005)
were decreasing, while the IDisp trends for NMR
(Z=+2.19, p=0.028) and CDR (Z=+2.39, p=0.017)
were increasing.
Conclusions The results show that at least for IMR
and U5MR, in addition to improvement in average
national levels, the geographical disparities have
decreased. In the cases of NMR and CDR, inspite of the
improvements in national levels, the trends of health
disparities are not as good. We need to use strategies to
provide more specialised care fairly in addition to
primary healthcare to reduce disparities in CDR and
NMR and influence them more.